International Classification of Functioning, Disability and Health (ICF) Domain Based on the underlying construct that the instrument is measuring, an instrument is categorized into an ICF domain (for more information, consult the World Health Organization’s ICF Framework website:http://www.who.int/classifications/icf/en/).
Domains used in SCIRE are:

  • Body Function and Structure
  • Activity
  • Participation
  • Environmental Factor

See Table 1 for definitions of the domains
See Table 2 for the categories used in each ICF domain to classify tools.

Interpretability The degree to which one can assign qualitative meaning (that is, clinical or commonly understood connotations) to an instrument’s quantitative scores or change in scores  (Fitzpatrick et al. 1998, MOT 2002).

Common measures include the SEM, MDC, and MCID (expanded on below). These are termed “clinically relevant values” in the Clinical Summary because these values allow a clinician to determine when a patient’s change in score actually indicates a change in the patient’s health/ability/function status.

  Standard Error of Measurement (SEM) Amount of error that can be considered measurement error. In a set of repeated scores, response consistency is measured (i.e. test-retest reliability or intra-rater reliability) and measurement error can be determined. (rehabmeasures)

When data is available in articles to calculate SEM, we did so using the following formula:

SEM = SD x sqrt(1 – ICC)


  • SD is the standard deviation of the sample mean is for the first trial, if multiple trials were conducted
  • ICC is the intra-class correlation for test-retest reliability or intra-rater reliability
  Minimal Detectable Change (MDC) Refers to the minimal amount of change in the instrument’s score that reflects true change (noticeable change in ability) by a patient between two time points (ensures change isn’t the result of measurement error). (Strokengine)

When data is available in articles to calculate MCID, we did so using the following formula:

MDC = SEM x 1.96

  Minimally Clinically Important Difference (MCID) The smallest difference in score in the domain of interest which patients perceive as beneficial. Changes between baseline and follow-up are examined in relation to their benchmark for a MCID, which was the patient’s follow-up assessment in a transition item of whether they were worse, better, or the same compared with the baseline assessment. (Strokengine). This value is less commonly reported, as it requires asking patients to assess what change in score provides actual tangible improvements in the underlying construct being measured.
Reliability Does the instrument produce results that are reproducible (free from random error) and internally consistent? (expanded on below) (Fitzpatrick et al. 1998, MOT 2002)
  Internal Consistency Based on the basic principle that several related observations provide more reliable estimate than a single observation. Therefore, it measures how inter-correlated items of a measure are with each other and the total score; that is, if the items are all measuring aspects of a single attribute or construct.
Generally assessed using Cronbach’s alpha, item-to-item and item-to-scale correlations. (Fitzpatrick et al. 1998, Terwee et al. 2007)
  Reproducibility Does the score give us an actual indication of the individual’s status or is it noise/ random error? We can measure this by taking repeated measures of an individual and examining whether the results stay the same, when the domain of measurement has not changed for the individual. The length of time between measurements should be long enough that individuals do not recall their previous answers, but not so long that it is possible the domain being measured has changed.

Generally assessed using correlation statistics including intra-class correlation coefficient (ICC), Pearson’s coefficient, Spearman’s coefficients and kappa coefficients. (Fitzpatrick et al. 1998, Salter et al. 2005)

  Test-retest reliability Repeat measurements of the same test are taken by an individual and their scores are examined for degree of difference between the tests
  Inter-rater reliability Repeat measurements of the same individuals are made by different raters and the scores are examined for degree of difference.
  Intra-rater reliability Repeat measurements of the same individuals are made by the same rater over a period of time and scores are examined for degree of difference
Validity Does the instrument measure what it claims to measure? (Fitzpatrick et al. 1998, MOT 2002)

The degree to which scores of an instrument are consistent with hypotheses, with regard to: 1) internal relationships, 2) relationships to scores of other instruments, and 3) differences between relevant groups.

Responsiveness Does the instrument detect clinically important changes (perhaps reflecting therapeutic effects) over time? (Fitzpatrick et al. 1998)

Generally assessed with effect size or standardized response mean (expanded on below)

  Effect size The size of change on a measure that occurs to a group between assessments compared with the variability of scores of that measure.

Commonly calculated as the difference between mean scores at assessments divided by the standard deviation of baseline scores. Usually expressed in standardized units that permit comparisons between instruments.

  Standardized Response Mean Differs from effect size only in that the denominator is the standard deviation of change scores in the group (take account of variability in change scores rather than baseline scores)
Floor/ceiling effects Floor (ceiling) effects occur when an instrument’s lowest (highest) score is unable to assess a patient’s level of ability, meaning that it is not possible to report most favorable or worst health states.

Usually measured by recording the number and percentage of participants with the highest and lowest score.

Acceptability How acceptable is the instrument in terms of completion by the participant – does it represent a burden? Can the assessment be completed by proxy?
(Fitzpatrick et al. 1998)
Feasibility Is the instrument easy to administer and process? (Consider extent of effort, burden, expense and disruption to staff/clinical care arising from administration of the instrument)
(Fitzpatrick et al. 1998)


Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment 1998; 2(14): 1-73.

Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice, Third Edition. Pearson Prentice Hall, 2009.

Rehabilitation Measures Database. Statistics Review. Available at:http://www.rehabmeasures.org/rehabweb/rhstats.aspx

Science Advisory Committee of the Medical Outcomes Trust. Assessing health status and quality-of-life instruments: Attributes and review criteria. Quality of Life Research 2002; 11: 193-205.

Salter K, Jutai JW, Teasell R, Foley NC, Bitensky J, Bayley M. Issues for selection of outcome measures in stroke rehabilitation: ICF activity. Disability and Rehabilitation 2005; 27(6): 315-340.

Stroke Engine Database. Glossary of Terms. Available at:http://strokengine.ca/assess/definitions-en.html

Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, Bouter LM, de Vet HCW. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology 2007; 60: 34-42.


Table 1: Definitions for Body function & structure, Activity and Participation

Functioning (positive aspect) Disability (negative aspect)
Body function: the physiological functions of the body systems including psychological functions. Impairment: problems with body function or structure.
Body structure: the anatomical parts of the body such as organs, limbs and their components.
Activity: the execution of a task or action by an individual Activity Limitation: difficulties an individual might experience in completing a given activity.
Participation: involvement in a life situation. Participation Restriction: problems an individual may experience with involvement in a life situation.


Table 2: ICF Domains and the categories used for classifying tools

Body Functions/Structures
  1. Mental functions & structures of the nervous system
  2. Sensory functions and pain & the eye, ear and related structures
  3. Functions & structures of the cardiovascular, haematological, immunological and respiratory systems
  4. Functions & structures of the reproductive system
  5. Neuromusculoskeletal and movement-related functions & structures
  6. Functions of the skin and related structures
  7. Functions – general
  1. Mobility
  2. Self-care
Quality of Life



4FTPSMW 4 Functional Tests for Persons who Self-Propel a Manual Wheelchair
6MWT 6 Minute Walk Test
6-MAT 6-Minute Arm Test
10MWT 10 Meter Walk Test
ADAPSS The Appraisals of Disability- Primary and Secondary Scale
AIS ASIA Impairment Scale
ASIA American Spinal Injury Association International Standards for Neurological Classification of SCI
ATD-PA Assistive Technology Device Predisposition Assessment
BI Barthel Index
BBS Berg Balance Scale
BBT Box and Block Test
BDI Beck Depression Inventory
BPI Brief Pain Inventory
BSI Brief Symptom Inventory
CES-D Centre for Epidemiological Studies Depression Scale
CHART Craig Handicap Assessment and Reporting Technique
CIQ Community Integration Questionnaire
COVS Clinical Outcome Variables Scale
CUE Capabilities of Upper Extremity Instrument
DASS-21 Depression Anxiety Stress Scale-21
EQR Emotional Quality of the Relationship Scale
ESES SCI Exercise Self-Efficacy Scale
FAI Frenchay Activities Index
FIM Functional Independence Measure
FIM-SR Functional Independence Measure Self-Report
FSS Fatigue Severity Scale
FST Functional Standing Test
GHQ-28 Scaled General Health Questionnaire-28
GRT Grasp and Release Test
HADS Hospital Anxiety and Depression Scale
I-QOL Incontinence Quality of Life Questionnaire
IADL Lawton Instrumental Activities of Daily Living scale
IPAQ Impact on Participation and Autonomy Questionnaire
K-B Scale Klein-Bell Activities of Daily Living Scale
KCAASS Knowledge, Comfort, Approach and Attitude towards Sexuality Scale
LIFE-H Assessment of Life Habits Scale
LISAT-9-11 Life Satisfaction Questionnaire
mFRT Modified Functional Reach Test
MPI-SCI Multidimensional Pain Inventory – SCI version
MPRCQ2 Multidimensional Pain Readiness to Change Questionnaire
MSES Moorong Self-Efficacy Scale
PARA-SCI Physical Activity Recall Assessment for People with Spinal Cord Injury
PASIPD Physical Activity Scale for Individuals with Physical Disabilities
PHQ-9 Patient Health Questionnaire-9
PSFS Penn Spasm Frequency Scale
QIF Quadriplegia Index of Function
QIF-SF Quadriplegia Index of Function-Short Form
QLI Quality of Life Index – Ferrans & Powers
QOLP-PD Quality of Life Profile for Adults with Physical Disabilities
QST Quantitative Sensory Testing
QUEST Quebec User Evaluation of Satisfaction with Assistive Technology
QWB Quality of Wellbeing
RMI Rivermead Mobility Index
RNL Reintegration to Normal Living
SAIQ Sexual Attitude and Information Questionnaire
SB Sexual Behaviour Scale
SCAT Self Care Assessment Tool
SCATS Spinal Cord Assessment Tool for Spastic Reflexes
SCI-FAI The Spinal Cord Injury Functional Ambulation Inventory
SCI-SCS Spinal Cord Injury Secondary Conditions Scale
SCI-SET Spinal Cord Injury Spasticity Evaluation Tool
SCILS Spinal Cord Injury Lifestyle Scale
SCIM Spinal Cord Independence Measure
SCIPUS Spinal Cord Injury Pressure Ulcer Scale
SCIPUS-A Spinal Cord Injury Pressure Ulcer Scale Acute
SCL CSQ Spinal Cord Lesion Coping Strategies Questionnaire
SCL EWB Spinal Cord Lesion Emotional Wellbeing Questionnaire
SCL-90-R Symptom Checklist-90-Revised
sEMG Surface Electromyography
SF-12 Short Form – 12
SF-36 Short Form – 36
SIAS Sexual Interest, Activity and Satisfaction Scale
SAS Sexual Activity and Satisfaction Scale
SIP-68 Sickness Impact Profile
SIS Sexual Interest and Satisfaction Scale
SMNAC Skin Management Needs Assessment Checklist
SRFM Self Reported Functional Measure
SWLS Satisfaction with Life Scale
THAQ Tetraplegia Hand Activity Questionnaire
TMT Timed Motor Test
TUG Timed Up and Go Test
VLT-SV Van Lieshout Test Short Version
WAnT Wingate Anaerobic Testing
WC Wheelchair Circuit
WHOQOL (BREF) World Health Organization Quality of Life Questionnaire – BREF
WISCI Walking Index for Spinal Cord Injury
WST Wheelchair Skills Test
WUSPI Wheelchair Users Shoulder Pain Index

Other Acronyms and Abbreviations Used

ICF domain International Classification of Functioning, Disability and Health domain
ICC Intra-Class Correlation
Spearman r Spearman correlation coefficient
tx Treatment
DOI Duration of Injury
UE Upper Extremity
LE Lower Extremity
SD Standard Deviation
SEM Standard Error of Measurement
MDC Minimal Detectable Change
MCID Minimal Clinically Important Difference
SRM Standardized Response Mean
ES Effect Size
ANOVA Analysis of Variance
IQR Inter-Quartile Range
RMSEA Root Mean Square Error of Approximation
CFA Confirmatory Factor Analysis
TLI Tucker Lewis Index
QOL Quality of Life
SCI Spinal Cord Injury
SCL Spinal Cord Lesion
MS Multiple Sclerosis
TBI Traumatic Brain Injury
F Female
M Male
PT Physical Therapist
OT Occupational Therapist
AB Able-Bodied
AUC Area Under Curve
ROC Receiver Operating Characteristic
CI Confidence Interval
YPI Years Post-Injury
PCA Principal Component Analysis
NS Non-significant